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Том 17. N 1-2 2013 р.
медичну допомогу, в юридично самослйш центри ПМД.
Ч^ке розмежування рiвнiв медичноТ допомоги, змiна застарiлих маршрупв пацieнта i, як результат, ефективний, доступний, швидкий контакт з медиком на первиншй ланцi мае величезн переваги для люди-ни i для лiкаря. Мета цього - доступ людини до фахь вця, який надае ягасну первинну медичну допомогу.
Впровадження таких пiдходiв потребуе ч^ко ви-значеноТ ресурсноТ пщтримки протягом декiлькох ро-кiв для усунення юнуючих диспропорцiй розвитку та проведення великоТ, складноТ роботи.
За пщсумками 2012 року в области функцiонувало 4 юридично самостiйних центри: 2 - в м. Комсомольську, 1 - в Лубенському району 1 - в Миргородському райош.
З 01.01. 2013 року в области розпочали роботу 22 юридично самослйних центри первинноТ медико-санiтарноТ допомоги - на сьогодн Тх 26. Виршуеться питання реестрацiТ центрiв ПМСД у 5 районах (Гребь нкiвський, Котелевський, Полтавський, Пирятинський, Чорнухинський).
На даний час ще не прийнято ршення сесп мiськоТ ради про створення центрiв ПМСД у м. Кременчуцк
В 2001 роцi показник охоплення населення надан-ням медичноТ допомоги за принципом амейного лка-ря становив 2,3%, в 2012 роц цей показник зрю i ста-новить 85,5%. Але цього ще недостатньо, так в ново-створених 22-х центрах ПМСД передбачено 882 посади лiкарiв, а в наявност 570 оаб, що складае 64,6% вiд потреби; середнiх та молодших медичних пра^в-никiв передбачено 2920 посад, а фiзичних оаб -2721, що складае 93% вщ потреби.
В процесi становлення первинноТ медичноТ допомоги на засадах загальноТ практики амейноТ медици-ни виникли фiнансовi та оргашзацшы проблеми:
1. Вiдсутнiсть державно закртленого коефiцiенту фiнансування цих закладiв, що може привести до розподту видатюв на первинну мережу на мюцевому рiвнi за остаточним принципом. Розподт видаткiв ко-ливаеться у межах вщ 19% (м. Полтава) до 48% (Ко-беляцький район), середшй по областi - 27,7%.
2. Вщсутнють можливостi надання соцiального пакету та стимулюючих методiв пра^вникам первинноТ ланки, який вiдпрацьовано в птотних територiях.
3. Високий вщсоток застарiлого медичного облад-нання (70%).
4. Недоукомплекта^я автотранспортом в цiлому.
Так нормативна гальгасть автомобiлiв в центрах
ПМСД област складае 532 одиницi. Передано на баланс 288 автомобов, з них 177 експлуатуються бть-ше 8 рокiв тобто, необхщно доукомплектувати 421 ав-томобiлем. В таких районах, як: Кобеляцький, Ново-санжарський, Полтавський, Хорольський автомобл передан в 100%, а в Козельщинському жодного.
5. Необхiднiсть отримання лщензи на медичну практику, що здшснюеться протягом 3 мiсяцiв пiсля Тх юридичноТ реестрацп. В державi вступили в силу 18 ачня 2013 року новi правила для ведення господар-ськоТ дiяльноcтi з медичноТ практики.
6. Реестра^я цeнтpiв ПМСД в переважшй бтьшо-cтi здшснюеться терит^ально в мicтaх та районних центрах, при цьому ряд нормативних аклв закртлю-ють пiльги медичним та фармацевтичним пра^вни-кам, яга працюють в закладах охорони здоров'я що розташован в ciльcькiй мюцевосп, а саме-оплата за стаж, додаткова вщпустка, оплата комунальних по-слуг тощо.
Надзвичайно важливо щоб вс ц нeдолiки були уcунутi, що дозволить вщпрацювати оптимальний маршрут патента, змiнити вiдношeння до своТх функцiй медичного персоналу, пapтнepcькi взаемини мiж ль карем i патентом та дбайливим ставленням людей до свого здоров'я.
Л^ература
1. Атун Р. Каковы преимущества и недостатки реструктуризации системы здравоохранения в целях большей ее ориентации на службы первичной медико-санитарной помощи?: доклад Сети фактических данных по вопросам здоровья / Р. Атун - Компенгаген: ЕРБ ВОЗ [Электронный ресурс]. - Режим доступа: htpp: // www.euro.who.int/document/e82997R.pdf. - Название с экрана.
2. Лехан В.М. Стратепя розвитку системи охорони здоров'я: украТнський вимip /В.М. Лехан, Г.О. Слабкий, М.В. Шевченко. - К., 2009. - 50 с.
3. Опт^за^я первинноТ медико-саытарно'Т допомоги населенню УкраТни: метод. рекомендацп / Н.Г. Гойда, Л.Ф. Матюха, Г.О. Слабкий, Л.В. Полкова; ДУ «Укр. 1н-т стратег. дослщж. МОЗ УкраТни», Нац. мед. акад.. пю-лядиплом. оcвiти iм. П.Л. Шупика. - К., 2010. - 25 с.
4. ОцЫка ефективност оргаызацп надання первинноТ медичноТ допомоги: метод. рекомендацп / Л.Ф. Матюха, Н.Г. Гойда, Г.О. Слабкий [та ш.]. - К., 2011. - 48 с.
5. Указ президента УкраТни вщ 12.03.2012 № 187/2012 «Про нацюнальний план дм на 2012 рк щодо впровадження Програми eкономiчних реформ на 2010-2014 роки «Заможне сусптьство, конкурентоспроможна економка, ефективна держава» // [Електронний ресурс]. Режим доступу: htpp: // zakon 2.rada.gov.ua/laws/show/187/2012.
6. Хобзей М.К. Медико-социальное обоснование оптимизации системы предоставления первичной медико-санитарной помощи (на примере Львовской области): Автореф. дис. доктора мед наук: 14.02.03 / Национальная медицинская академия последипломного образования имени П.Л. Шупика. - К, 2010. -38 с.
7. Boerma G. W. Роль общей практики в первичной медико-санитарной помощи [Электронный ресурс] / G. W. Boerma, D. M. Fleming. - Копенгаген : ВОЗ. Европейское региональное бюро, 2001. - Режим доступа: http://openlibrary.org/b/0L22478056M/role_of_general_pr actice_in_primary_health_care
8. Denmark: Health system review /M. Olejaz, A. Juul Nielsen, A. Rudjibing [et al.] // Helth System in Transition. -2012. - Vol. 14 (2). - P. 1-192
English version: EXPERIENCE IN MODERNIZATION OF PRIMARY HEALTH CARE ON THE BASIS OF FAMILY MEDICINE AND
5k
SECONDARY HEALTH CARE IN POLTAVA REGION FOR 2012
Lysak V.P.
Healscare Department of Poltava region municipal administration
* To cite this English version: Lysak V.P. Experience in modernization of primary health care on the basis of family medicine and secondary health care in poltava region for 2012// Problemy ekologii ta medytsyny. - 2013. - Vol 17, № 1-2. - P. 17-19.
npoSAeMH eKOAorii Ta MejHUHHH
This paper focuses on the experience in the reorganization of primary and secondary health care throughout Poltava region for 2012. The principal official record which has determined the activities and main approaches for the development of Poltava region health care for 2012 is the National program 2012 about implementation of Program of economic reforms in Ukraine for 2012 - 2014 "Wealthy society, competitive economics, effective state". The reorganization of healthcare institutions in the region has been carried out. It has included the separating of structural subdivisions providing primary health care services from central district and municipal hospitals and recognizing them as legally relevant independent centers of primary health care. To implement the Regulation of the Cabinet of Ministers, June 28, 1997, № 640, subject to medical and economic efficiency of a patient capacity during 2012 many efforts have been focused on the accomplishment of bed stock at health care institutions throughout the region. We have analyzed organizational and financial issues as well as outline the approaches to overcome them that will result in the improvement of population's health.
Key words: health care reorganization, primary health care, secondary health care, Poltava region.
Much attention has been paid to the reorganization of health care network, namely central district and municipal hospitals by separating them from structural units that provide primary care and recognizing them as legally independent centers providing primary health care.
Strict distinction between the levels of health care, changing the patients' old itinerary and as a result, effective, accessible, fast contact with a physician in primary care has huge benefits for the persons and the doctor. Therefore, the purpose of this is to provide the residences to have access to specialists who provide qualified primary health care.
Implementation of such approaches needs well-defined supporting resources for several years to eliminate existing development disproportions and to carry out huge and thorough work.
According to the previous year results 4 legally independent centers started their functioning in Poltava region: 2 - in Komsomolsk, 1- in Lubny district, 1- in Myr-gorod district.
Since January, 01, 2013 twenty two legally independent primary health care centers (PHCC) have started their work in Poltava region. There are 26 nowadays. The issue on PHCC registration is currently being solved in 5 districts (Grebinka,Kotelva, Poltava, Pyryatyn, Chor-nukhy). The municipal council session decree on establishment of PHCC in Kremenchuk has not been adopted yet.
In 2001 the range index of medical service for population based on principles of family medicine made up 2, 3%, and this index increased and now it constitutes 85.5%. For 22 new PHCC centers 882 medical posts are planned, but only 570 are available that makes up 64,6% of those required; nursing and medical attendant stuff composes 2920 posts according to the plan, but physical persons occupy 2721 posts that makes up 93%.
In the implementation of primary medical care based on the family medicine approach the following financial and organizational problems arise:
1. Lack of the state fixed financing ratio can cause expense distribution by the residual principle among the primary network establishments of the local level. Expense distribution fluctuates within the limits from 19% (Poltava) to 48% (Kobelyaku district), average in Poltava region is 27,7%.
2. Lack of the social package granting for the primary link specialists and stimulating methods that have been experienced in the pilot territories.
3. High percentage of outdated medical equipment (70%).
4. Lack of motor transport on a whole. The standard quantity of cars in PHCC composes 532 units. The total car amount constitutes 288, among them 177 were in use more than 8 years. Now more than 421 cars are required. Such districts as Kobelyaky, Novi- Sanzhary, Poltava,
Introduction
The primary health care takes on special significance under conditions of reformation of health protection since one of the principal priorities for the enhancement of the national health care systems has to be the development of primary health care on the base of general practice of family medicine [2,7].
Current investigations indicate the positive relation between the level of the development of primary health care in the country and population health, and particularly between the level of general mortality as a result of coronary heart disease and malignancies, infantile mortality and life expectancy of population [6,8]. Furthermore the change-over from conventional health care to medical care according to the principles of primary health care determined by WHO, which influence the health care effectiveness that may be manifested as upgrading, complete patients satisfaction, doctors' motivation improvement and others. Therefore the reformation of primary health care on the base of general practice of family medicine will contribute to its effectiveness and potency and will have an effect on quality of the secondary health care [3,4].
The object of paper is to analyze the experience of primary health care reformation on the base of general practice of family medicine and secondary health care in Poltava region in 2012.
Material and Methods: informational and analytic.
Results and discussion
The key state efforts in the field of health protection are directed to the reformation of the system of medical service for population in 2012, which is an important part of social and economic transformations at the national and regional levels (as national and regional standards).
According to the results of regional treatment and preventive establishments work in 2012 one of immediate tasks for reformation in the field is priority health care development on the base of general practice - family medicine.
The key document describing the directions for the work and development in the field of health protection for the region in 2012 is the National program 2012 about implementation of Program of economic reforms in Ukraine for 2012 - 2014 "Wealthy society, competitive economics, effective state" [5].
In accordance to paragraph 32 of the National plan for 2012 the reorganization of primary health care is one of the priorities of the way for its improvement through modernization and network analysis: the development of general practice services, family medicine, the expansion of outpatient medical rooms in rural areas and the creation of independent legal centers of primary health care.
TOM 17. N 1-2 2013 P.
Khorol are provided with motor transport on 100%, but there is no one in Kozelschyna district.
5. License on medical practice should be obtained during 3 months after legal registration according to the new state regulations concerning the medical practice managerial (economic) activities adopted on January, 18, 2013.
6. Registration of PHCC is mainly realized locally therefore several standard regulations fixe social benefits (pay increase for the length of service, annual additional leave, municipal services payment and so on) for the medical specialists working in the rural areas .
The elimination of all the drawbacks will provide means for determination optimal patient's itinerary, changing the medical personnel attitude to their functional duties, working doctor-patient partnership and careful attitude of the people to their health.
In contrast to the primary health care the inpatient medical service requires high expenses for engagement of highly qualified specialists, up-to-date equipment, maintenance expenses, pharmaceutical provision, that is the formed technological process.
- To implement the Regulation of the Cabinet of Ministers, June 28, 1997, № 640, subject to medical and economic efficiency of a patient capacity during 2012 many efforts have been focused on the accomplishment of bed stock at health care institutions throughout the region.
In 2012 the initial hospital admission decreases on 173 units when the bed population ratio per 10 thousand composes 81.0 (2011 - 82.14, optimal - 80.0). Nowadays the number of population tends to annual decrease, but the bed population ratio is higher than required.
Therapeutic patient capacity is functioning only on 51% of the total quantity but its effectiveness is deficient as in Kozelschyna district (193.4), Dykanka district (228.8), Poltava district (246,6), Orzhytsya district (249,4).
- Surgical patient capacity is functioning partially because less than 10 surgical interferences per unit of surgical patient capacity are performed during the year (Orzhytsya, Shyshakhy and Reshetilovka districts).
The bed stock arrangement is carrying out taking into account the population needs in inpatient medical care and helps to provide proper functioning of the patient capacity, appropriate inpatient medical care.
Detailed personnel, financial and economic analysis of Poltava region health care establishments stated the presence of the wide network of secondary level medical care units that have administrative and regional subordination and different budgets.
Nowadays the bed stock of Poltava region amounts:
- therapeutic beds - 51%
- surgical beds - 23%
- obstetric and gynecological beds - 11%
- pediatric beds - 12%
- medical rehabilitation beds - 1%,
- medical care and social services beds - 1%,
- hospice service beds - 1%.
Thus, having been reorganized the structure of bed stock in Poltava region is presented in the following way:
- therapeutic patient capacity makes up 24%
- surgical beds - 23%,
- obstetrical and gynecological beds - 18%,
- pediatric beds - 12%,
- beds fro medical rehabilitation - 11%,
- beds for medical and social care - 9%
- hospice care beds - 3%.
Nowadays both the first stage of auditing "Self-evaluation of characteristics in providing secondary (specialized) health care by health care institutions" and the second stage "Revision of subjectivity for characteristics obtained at the first stage" have been completed. Data obtained enable to examine predesign for the organization of hospital circuits and hospitals for intensive treatment throughout the region.
To fulfill the challenges issued by the President of Ukraine we have designed the Plan - schedule for reorganization of health care system in Poltava region for 2010 - 2014 and approved it by Poltava regional administration and Poltava region Rada (council). Corresponding plans have been worked up for the districts and cities of the Poltava region as well. The plans of socioeconomic development for each territory involve health care issues as an integral part. We have also analyzed medical provision and activities of the health care institutions, have formulated basic approaches towards the structural and functional modifications in the domestic health care system.
Therefore, the recognition of these challenges makes it possible to pose the following strategic objectives towards the health care system in 2013:
- further development of family medicine network;
- organization of primary medical sanitary care centers as legal entity;
- improvement in supporting with skilled personnel for primary health care;
- further implementation of interdisciplinary approaches in diagnosis and treatment;
- amelioration in training of general practitioners;
- reinforcement of material and technical resources for primary health care institutions.
With respect to the secondary health care it should be emphasized on the importance to renovate certain approaches in specialized health care; to complete the third stage of auditing of secondary health care and to prepare required documentation for the fourth stage of the auditing; to proceed with the regulation of bed stock and organization of hospitals for intensive treatment throughout the region.
Conclusions
All the measures mentioned above are directed towards the improvement and reorganization of primary and secondary health care. They have been designed to reduce the population's morbidity and mortality rates, to decrease the disablement of any types, to detect diseases in their early stages especially those which are of social significance as cardiovascular pathologies, malignancies, tuberculosis, AIDS; to prevent non-infectious diseases and to develop personal deliberate attitude and responsibility for own health and safety, to enhance the potential of national health care system.
Referencis
1. Atun R. Kakovy preimuschestva i nedostatki restrukturizazii sistemy zdravoochraneniya v zelyach bol'shey ee orientazii na sluzhby pervichnoy mediko-sanitarnoy pomoschi?: doklad Seti fakticheskich dannych po voprosam zdorov'ya / R. Atun - Kompengagen: ERB VOZ [Elektronnyy resurs]. - Rezhim dostupa: htpp: // www.euro.who.int/document/e82997R.pdf. - Nazvanie s ekrana.
2. Lechan V.M. Strategiya rozvitku sistemi ochoroni zdorov'ya: ukraïns'kiy vimir /V.M. Lechan, G.O. Slabkiy, M.V. Shevchenko. - K., 2009. - 50 s.
npoSAeMH eKOAoriï Ta MejHUHHH
3. Optimizaziya pervinnoï mediko-sanitarnoï dopomogi naselennyu Ukraïni: metod. rekomendaziï / N.G. Goyda, L.F. Matyucha, G.O. Slabkiy, L.V. Polikova; DU «Ukr. In-t strateg. doslidzh. MOZ Ukraïni», Naz. med. akad.. pislyadiplom. osviti im. P.L. Shupika. - K., 2010. - 25 s.
4. Ozinka efektivnosti organizaziï nadannya pervinnoï medichnoï dopomogi: metod. rekomendaziï / L.F. Matyucha, N.G. Goyda, G.O. Slabkiy [ta in.]. - K., 2011. -48 s.
5. Ukaz prezidenta Ukraïni vid 12.03.2012 № 187/2012 «Pro nazional'niy plan diy na 2012 rik schodo vprovadzhennya Programi ekonomichnich reform na 2010-2014 roki «Zamozhne suspil'stvo, konkurentospromozhna ekonomika, efektivna derzhava» // [Elektronniy resurs]. Rezhim dostupu: htpp: // zakon 2.rada.gov.ua/laws/show/187/2012.
6. Chobzey M.K. Mediko-sozial'noe obosnovanie optimizazii sistemy predostavleniya pervichnoy mediko-sanitarnoy
pomoschi (na primere L'vovskoy oblasti): Avtoref. dis. dok-tora med nauk: 14.02.03 / Nazional'naya medizinskaya akademiya poslediplomnogo obrazovaniya imeni P.L. Shupika. - K, 2010. -38 s.
7. Boerma G. W. Rol' obschey praktiki v pervichnoy mediko-sanitarnoy pomoschi [Elektronnyy resurs] / G. W. Boerma, D. M. Fleming. - Kopengagen: VOZ. Evropeyskoe regional'noe byuro, 2001. - Rezhim dostupa: http://openlibrary.org/b/OL22478056M/role_of_general_pr actice_in_primary_health_care
8. Denmark: Health system review /M. Olejaz, A. Juul Nielsen, A. Rudjibing [et al.] // Helth System in Transition. -2012. - Vol. 14 (2). - P. 1-192
MaTepia/ HagiïwoB go pegawiï26.09.2012 p
